我国非营利性医院补偿机制缺陷浅析

Analysis of the defects in reimbursement mechanism of non-profit hospitals

由于政府财政对卫生投入的比例下降,非营利性医院的人均卫生事业费不足于全国在岗职工工资的四分之一,每个医院取得的专项补助费不足于补偿专业设备的年折旧费。医疗服务项目收费标准在反映价值和反映供求关系方面,比价关系扭曲,医务人员的劳务技术价值被严重低估。医院为求生存求发展,最大限度的依赖药品收入和依赖设备型服务项目。以药“补”医演变成了以药“养”医,使全国药费支出近二千亿元,占我国卫生总投入的三成至四成,远远高于发达国家的这一比例;各医院竞相购置各种医疗设备,使医疗资源浪费严重,出现诱导消费、过度医疗。这些因素共同导致了药费开支失控、医疗服务项目畸形发展以及“看病难、看病贵”等一系列不良后果,医疗服务的发展进入一种恶性循环状态。所以,政府提高其卫生投入及其效率,制定出具有“指导性”的“政府指导价”,让医“戒”药而“自立”,应是打断医疗服务发展恶性循环的逻辑起点。

The data revealed that： 1）the ratio of the government＇s health budget was decreasing year by year; 2）the per capita of the wage appropriation for the non-profit hospital （NPH） personnel was less than the quarter of average level of national workers; 3）the per capita of the given purpose appropriation for the NPH was not enough to cover the equipment yearly depreciation; 4） and the medical service fee scales were not rational and the price to provide health was seriously below the medical professional commitment. As the primary result, the hospitals relied on the reimbursement more from the iteins of medications sale and the examination services through expensive equipment to survive and develop while less on techniques related to intelligence or services. As the second result, the policy of medications-subsidized-hospital evolved into a situation of medications-fed-hospital, which, in turn, stimulated the total charge for medications soaring to 200 billion yuan a year, accounting for 30 to 40 percent of the nationwide health fiscal input, with the higher proportion than many developed countries. As the third result, hospitals struggled to arm with the expensive medical equipments and led to the low efficiency and waste for the medical resource, over-servicing and inducing the unnecessary medical consuming. And, as the fourth result, the uncontrolled high expenses of medications caused the so- called ＂expansive and difficult to-see-a-doctor＂. Consequently, medical service development jumped into a deteriorating circle. Therefore, in order to break away from the deterioration, it is suggested that the governments should fortify the health input, improve the financial efficiency and set up the policy on ＂government recommending expenses＂, and the income resource of hospitals should be isolated from the expenses of medications.